4 jumbo jets a week?!?!

That would be a bad week for aviation. I'm surprised there isn't more in the news about this. Maybe it's because the deaths are individual, random, and spread all over. If it happened in bunches it might be more newsworthy.

mainlytext.com/bike.html Bicycling in winter, the entertainment version

That sounds about right. The number 3 killer behind heart disease and cancer is iatrogenic (doctor caused) death. About 1/4 million per year.

"He who serves all, best serves himself" Jack London

Originally Posted by Bjforrestal

I don't care if you are on a unicycle, as long as you're not using a motor to get places you get props from me. We're here to support each other. Share ideas, and motivate one another to actually keep doing it.

That's the rub. The health care you are paying for is the third most dangerous killer.

"He who serves all, best serves himself" Jack London

Originally Posted by Bjforrestal

I don't care if you are on a unicycle, as long as you're not using a motor to get places you get props from me. We're here to support each other. Share ideas, and motivate one another to actually keep doing it.

See, are these 747SPs or A-380-800s? There's a big difference there, and let's not even get into if they have European charter operator sardine-can seating or a 3- or 4- class setup with first class suites?

If you ever want to know why there are so many medical malpractice suits, it's because there's so much malpractice.

Actually, I can speak to this because I do it for a living. Malpractice suits are probably about the least efficient way to compensate injured people. Most of the money is sucked up in transactional costs. For example, unless a state has caps on damages and fees, the typical plaintiff attorney contingency fee in a medmal case is 50%. This is higher than the typical 33% of most personal injury cases, because the chance of winning is less, so the attorney needs more money to compensate them for the higher risk of not getting anything. Then there come the costs of litigating the case.

So say a case goes to trial and the injured person is awarded $ 1 million. The plaintiff attorney takes her fee of $ 500,000 off the top. Then she takes the costs that had been advanced. In a typical malpractice case, these may be $ 100,000, for expert witnesses, copies of records, travel, deposition fees and jury consultants. So out of that $ 1 million verdict, the injured party gets $ 400,000. However, the plaintiff attorney only gets this if they win or settle the case. If they lose, they get nothing. The defense attorneys get paid win or lose.

And of the medmal cases that go to trial, physicians win about 75% of the time and hospitals win about 60% of the time. So does that mean that no malpractice occurred? The problem is that most laypeople equate any bad or less than perfect result as malpractice, but the law does not. Not every mistake reaches the level of malpractice, and you establish or defend this by expert testimony. And malpractice cases don't result in changes in practice that often, and the physician and hospitals have insurance, so I am not sure that they have much of a deterrent effect. Also injured people with demonstrable malpractice sometimes cannot find attorneys because the damages and potential award are too small to make it worthwhile for the attorney to take the case.

If I could wave a magic wand, we would treat malpractice cases like some states do workers' compensation or disability cases: a panel of medical, judicial, plaintiff legal and defense legal, and some laypeople would hear cases; decide if liability was present; and assign an award and plaintiff and defense attorney fees using a schedule. But the current system is too entrenched to be changed, absent some controlling Federal legislation that withstands Constitutional challenge, which is highly unlikely.

There is no doubt that too many errors occur and they need to be fixed. Relying on the malpractice system to do so, however, is a forlorn hope.

Our medical care system does exactly what it's designed to do - make profits for the drug and insurance companies. Healthy patients aren't as profitable as sick ones, and that's why we spend more than the rest of the world does on medical care, but end up competing with the likes of Costa Rica in terms of health.

Actually, I can speak to this because I do it for a living. Malpractice suits are probably about the least efficient way to compensate injured people. Most of the money is sucked up in transactional costs. For example, unless a state has caps on damages and fees, the typical plaintiff attorney contingency fee in a medmal case is 50%. This is higher than the typical 33% of most personal injury cases, because the chance of winning is less, so the attorney needs more money to compensate them for the higher risk of not getting anything. Then there come the costs of litigating the case.

So say a case goes to trial and the injured person is awarded $ 1 million. The plaintiff attorney takes her fee of $ 500,000 off the top. Then she takes the costs that had been advanced. In a typical malpractice case, these may be $ 100,000, for expert witnesses, copies of records, travel, deposition fees and jury consultants. So out of that $ 1 million verdict, the injured party gets $ 400,000. However, the plaintiff attorney only gets this if they win or settle the case. If they lose, they get nothing. The defense attorneys get paid win or lose.

And of the medmal cases that go to trial, physicians win about 75% of the time and hospitals win about 60% of the time. So does that mean that no malpractice occurred? The problem is that most laypeople equate any bad or less than perfect result as malpractice, but the law does not. Not every mistake reaches the level of malpractice, and you establish or defend this by expert testimony. And malpractice cases don't result in changes in practice that often, and the physician and hospitals have insurance, so I am not sure that they have much of a deterrent effect. Also injured people with demonstrable malpractice sometimes cannot find attorneys because the damages and potential award are too small to make it worthwhile for the attorney to take the case.

If I could wave a magic wand, we would treat malpractice cases like some states do workers' compensation or disability cases: a panel of medical, judicial, plaintiff legal and defense legal, and some laypeople would hear cases; decide if liability was present; and assign an award and plaintiff and defense attorney fees using a schedule. But the current system is too entrenched to be changed, absent some controlling Federal legislation that withstands Constitutional challenge, which is highly unlikely.

There is no doubt that too many errors occur and they need to be fixed. Relying on the malpractice system to do so, however, is a forlorn hope.

Several people that I went to law school with do medmal and none of them charge a 50% contingency fee. They run 33% if settled before MSJ and 40% afterward, plus costs. Of course most cases settle, but the few that have gone to trial the costs have been significant because the case was extreme. The sad fact is most victims of medmal don't ever file suit because of the difficulty of proving causation.

The few, the proud, the likely insane, Metro-Atlanta bicycle commuters.

Can you really call 80,000 deaths from infection "medical errors"? I know you can take measures to minimize infection risk, but I don't think you can call every infection that occurs in a hospital a medical error.

And the 106,000: They are labeled "non-errors". Are they errors or not?

I stop for people / whose right of way I honor / but not for no one.

Originally Posted by bragi"However, it's never a good idea to overgeneralize."

Several people that I went to law school with do medmal and none of them charge a 50% contingency fee. They run 33% if settled before MSJ and 40% afterward, plus costs. Of course most cases settle, but the few that have gone to trial the costs have been significant because the case was extreme. The sad fact is most victims of medmal don't ever file suit because of the difficulty of proving causation.

In my areas of the West Coast that do not have a cap on fees (such as California due to MICRA), the typical contingency fee is 50% if the case goes to trial. I settled a case just yesterday in eastern Washington halfway through trial and the plaintiff attorney in that case is charging 50%, which is par for the course in this area for the big-name plaintiff attorneys. But there are some areas where due to state laws, the presence of legal competition, judicial requirements, Bar rules or the like, that a contingency fee may be lower.

And if you can't find an expert on liability or causation, perhaps there is no malpractice as defined by the law, eh? Again, sometimes bad things happen to good people and that does not in and of itself mean that someone screwed up. Although in America we like to think so, and preferably the people who screwed up have insurance that we can go after.

PS: I forgot to mention: in my world, most of the cases do not settle. I enclose here a snippet from the PIAA data sharing report, which is the most extensive physician malpractice data base available. Note that less than a third of all cases have money paid out in through a settlement or award. This is consistent with my own experience, except I make an indemnity (settlement or award) payout on a little less than 40% of my cases.

PIAA Data Sharing Project

The PIAA Data Sharing Project is an on-going claim study, which currently now includes 22 of PIAA member companies submitting their claims data semi-annually. The Data Sharing Project contains information on closed claims and suits, and open suits that have been open for one year. This effort, which began in 1985, has accumulated more than 274,000 claims and suits through June 2009, of which over 93% are closed. Of the closed claims, approximately 27% are closed with an indemnity payment. The system includes claims against physicians, dentists, other healthcare providers and professional corporations.

Can you really call 80,000 deaths from infection "medical errors"? I know you can take measures to minimize infection risk, but I don't think you can call every infection that occurs in a hospital a medical error.

And the 106,000: They are labeled "non-errors". Are they errors or not?

Just so you know, there is quite the debate in healthcare as to scope of the numbers and how the numbers are calculated in terms of death or adverse outcomes that are only due to iatrogenic errors, and not any other contributory causes. You can do a Medline search to get a sense of what the literature is saying. These are all estimates, and there is no consensus on the methodology used to come up with these numbers. Clearly, people do die or are injured solely from iatrogenic errors, and we need to address that instead of arguing over the numbers.

If I was Queen of the United States, one of the first acts I would do is wave my scepter and create a Federal system for the uniform reporting and analysis of medical errors. There is none currently, and that makes it hard to benchmark or to compare apples to apples. We cannot solve the problem without reliable and consistent data and the analysis thereto.